DR. SAMUEL THOMAS GONTKOVSKY (NPI# 1801954920) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801954920 |
| Entity Type | Individual |
| Full Name | DR. SAMUEL THOMAS GONTKOVSKY |
| Credential | PSY.D. |
| Practice Address |
W175n11163 Stonewood Dr Ste 200 Germantown WI 53022-6502 |
| Mailing Address |
W175 N11163 Stonewood Drive Suite 200 Germantown WI 53022 |
| Practice Telephone | (262) 244-6177 |
| Practice Fax Number | 2622993040 |
| Mailing Telephone | (262) 244-6177 |
| Mailing Fax Number | 2622993040 |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2017-05-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC0700X |
Psychologist Specialization: Clinical |
3446-57 | WI | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
7285 | OH | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
723 | NE | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
42692 | MS | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0108112 | 05 |
| Street Address |
W175N11163 STONEWOOD DR STE 200 |
| City | GERMANTOWN |
| State | WI |
| Zip Code | 53022-6502 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831669407 | Margaret Jo Mulder | Chiropractor | W164 N11269 Squire Drive Suite B, Germantown, WI 53022 | 2018-11-27 |
| 1316441579 | Community Home Care Services | Home Health | N112 W16298 Mequon Rd, 127, Germantown, WI 53022 | 2018-03-22 |
| 1811426224 | Wi-care LLC | In Home Supportive Care | W175n11163 Stonewood Drive Ste 220, Germantown, WI 53022 | 2017-06-08 |
| 1134675358 | Kojo Bempong | Anesthesiologist Assistant | Ahcmg Anesthesiology, 4025 North 92nd Street, Wauwatosa, WI 53022 | 2016-08-28 |
| 1336501915 | Ashley Russell | Occupational Therapist | W175 N11117 Stonewood Drive, Suite 100, Germantown, WI 53022 | 2016-03-23 |
| 1134535735 | Erin Therese Grueneberg | Nurse Practitioner | W153 N9990 Neptune Drive, Germantown, WI 53022 | 2014-07-03 |
| 1306286836 | Kyle W Mcmahon | Occupational Therapist | W175 N1117 Stonewood Drive, Suite 100, Germantown, Wi, WI 53022 | 2013-06-28 |
| 1326354713 | Brittany Skogg | Physical Therapist | W175 W11117 Stonewood Dr., Suite 100, Germantown, WI 53022 | 2010-08-24 |
| 1669635066 | Joseph D Deguzman Dds Ms Sc | Clinic/Center | W172 N9723 Division Road, Suite A, Germantown, WI 53022 | 2008-07-07 |
| 1457513988 | Rustin A. West | Dentist | W172 N9723 Division Road Suite A, Germantown, WI 53022 | 2008-06-26 |
| Find all providers in zip 53022 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750637310 | Andrea Lynn Morley | Psychologist | 20528 Boland Farm Rd Ste 207, Germantown, MD 20876-4038 | 2012-07-31 |
| 1295090421 | David Mahoney | Psychologist | 20400 Observation Dr Ste 103, Germantown, MD 20876-4086 | 2012-07-13 |
| 1992994503 | Bernard L Brookes | Psychologist | 20407 Waters Point Ln, Germantown, MD 20874-1066 | 2007-10-19 |
| 1578698460 | Charles Page Hannaford | Psychologist | 2176 West St Ste 200 A, Germantown, TN 38138-3859 | 2007-02-22 |
| 1437231511 | Catherine Morton | Psychologist | 2022 Exeter Rd # 1, Germantown, TN 38138-3945 | 2006-10-19 |
| 1003839887 | William Rayburn Gentry Jr. | Psychologist | 1922 Exeter Rd, Suite 7, Germantown, TN 38138-2949 | 2006-07-25 |
| 1295715472 | North Star Counseling Services, LLC | Psychologist | W175n11163 Stonewood Dr., Suite 225, Germantown, WI 53022-6503 | 2006-01-22 |
| 1487288361 | Rachel L Micol | Psychologist | 13240 Executive Park Ter, Germantown, MD 20874-2640 | 2020-02-28 |
| 1841832318 | Brittany Ann Kinman | Psychologist | 7516 Enterprise Ave, Germantown, TN 38138-3802 | 2019-10-16 |
| 1437708146 | Adrienne Pena | Psychologist | 20680 Seneca Meadows Pkwy Ste 217, Germantown, MD 20876-7029 | 2019-09-05 |
| Find all providers in GERMANTOWN | ||||
| City | GERMANTOWN |
| Zip Code | 53022 |
Please comment or provide details below to improve the information on DR. SAMUEL THOMAS GONTKOVSKY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.